维生素D3在2型糖尿病并结直肠息肉与结直肠癌中的表达

Vitamin D3 expression in patients with type 2 diabetes mellitus complicated by colorectal polypsand colorectalcancer

目的探讨2型糖尿病伴血糖控制不佳合并结直肠息肉或结直肠癌患者中维生素D3的表达，分析其相关性。 方法选取2型糖尿病患者120例为研究对象，根据血糖控制标准及结直肠息肉/结直肠癌的诊断，分为2型糖尿病伴血糖控制不佳[糖化血红蛋白（HbA1c）〉6.5%]组（其中合并结直肠息肉30例为A组，合并结直肠癌30例为B组）、2型糖尿病伴血糖控制良好（HbA1c〈6.5%）组（其中合并结直肠息肉30例为C组，合并结直肠癌30例为D组）；另选取同期无糖尿病患者60例设为无糖尿病组（其中合并结直肠息肉30例为E组，合并结直肠癌30例为F组）。入组研究对象均检测1，25-二羟维生素D3[1，25-（OH）2-VD3]、血糖、HbA1c，并行胃肠镜检查。观察血清1，25-（OH）2-VD3与HbA1c、空腹血糖相关性；分析血清1，25-（OH）2-VD3与胰岛素抵抗的相关性；不同1，25-（OH）2-VD3水平2型糖尿病伴血糖控制不佳患者出现结直肠息肉或结直肠癌的情况。 结果各组患者1，25-二羟维生素D3、空腹血糖、HbA1c表达差异有统计学意义（P〈0.05）。合并结直肠癌的B、D、F组HbA1c、空腹血糖水平分别高于合并结直肠息肉的A、C、E组（P〈0.05）；B、D、F组1，25-（OH）2-VD3水平分别低于合并结直肠息肉的A、C、E组（P〈0.05）。血清1，25-（OH）2-VD3与HbA1c、空腹血糖均呈负相关（P均〈0.05）。各组患者血清1，25-（OH）2-VD3水平及胰岛素抵抗相关指标比较差异有统计学意义（P〈0.05）。1，25-（OH）2-VD3与胰岛β细胞功能（HOMA-β）、胰岛素敏感指数（ISI）均呈正相关（P〈0.05），与胰岛素抵抗指数（HOMA-IR）、胰岛素均呈负相关（P〈0.05）。1，25-（OH）2-VD3水平缺乏（〈25 μg/L）者中2型糖尿病伴血糖控制不佳患者出现合并结直肠息肉或结直肠癌的比例高于1，25-（OH）2-VD3水平非缺乏（≥25 μg/L）者，差异有统计学意义（P〈0.05）。 结论2型糖尿病伴血糖控制不佳合并结直肠息肉或结直肠癌患者中1，25-（OH）2-VD3水平呈低表达，1，25-（OH）2-VD3与2型糖尿病并结直肠息肉或结直肠癌患者的血糖控制呈负相关，且与胰岛素抵抗相关指标存在良好相关性，1，25-（OH）2-VD3缺乏的2型糖尿病伴血糖控制不佳患者合并出现结直肠息肉或结直肠癌的概率可能增大。

ObjectiveTo study the expression of vitamin D3 in type 2 diabetes mellitus patients with poor glycemic control complicated by colorectal cancer or colorectal polyps. MethodsA total of 120 patients with type 2 diabetes were selected as the research objects. According to the diagnostic standard for blood glucose control and diagnosis of colorectal polyps/colorectal cancer, the 120 patients were divided into two groups： type 2 diabetes with poor glycemic control group [glycosylated hemoglobin A1 c （HbA1c〉6.5%）], type 2 diabetes with good glycemic control group （HbA1c〈6.5%）. In type 2 diabetes with poor glycemic control group, 30 cases with colorectal polyps were further allocated to group A, and 30 cases with colorectal cancer were allocated to group B; in type 2 diabetes with good glycemic control group, 30 cases with colorectal polyps were allocated to group C, and 30 cases with colorectal cancer were allocated to group D. Sixty patients without diabetes in the same period were selected as non diabetic group （30 cases with colorectal polyps were set up as group E, and 30 cases with colorectal cancer were set up as group F）. 1, 25-dihydroxyvitamin D3 [1, 25-（OH）2-VD3], blood glucose and HbA1c in subjects were detected, and each patient underwent gastrointestinal endoscopy. The relationship between serum 1, 25-（OH）2-VD3 and HbA1c, fasting blood glucose was observed; and the relationship between serum 1, 25-（OH）2-VD3 and insulin resistance was analyzed. The occurrence of colorectal polyps or colorectal cancer in type 2 diabetes patients with poor glycemic control of different 1, 25-（OH）2-VD3 levels was observed. ResultsThere were significant differences in 1, 25-（OH）2-VD3, fasting blood glucose and HbA1c expression among each group （P〈0.05）. The levels of HbA1c and fasting blood glucose in group B, D, F were higher than those in group A, C and E, respectively （P〈0.05）; the 1, 25-（OH）2-VD3 levels in group B, D, F were lower than those in group A, C, E （P〈0.05）. There were negative correlations among serum 1, 25-（OH）2-VD3 with HbA1c, fasting blood glucose （P〈0.05）. There were significant differences in serum 1, 25-（OH）2-VD3 level and insulin resistance related indexes among each group （P〈0.05）. There were positive correlations among 1, 25-（OH）2-VD3, homeostasis model assessment-β （HOMA-β）, insulin sensitivity index （P〈0.05）; and 1, 25-（OH）2-VD3 was negatively correlated with HOMA-IR and insulin （P〈0.05）. The proportion of colorectal polyps or colorectal cancer in type 2 diabetes mellitus patients with 1, 25-（OH）2-VD3 deficiency[1, 25-（OH）2-VD3 〈25 g/L] and poor glycemic control was higher than that of paithes with 1, 25-（OH）2-VD3 levels more than 25 g/L, the difference was significant （P〈0.05）. ConclusionsThe expression of 1, 25-（OH）2-VD3 level is low in type 2 diabetes patients with poor glycemic control and colorectal polyps or colorectal cancer. 1, 25-（OH）2-VD3 is negatively correlated with glycemic control in patients with type 2 diabetes complicated by colorectal polyps or colorectal cancer, and has good correlation with insulin resistance related indicators. The probability of development of colorectal polyps or colorectal cancer may increase in patients with type 2 diabetes mellitus complicated by 1, 25-（OH）2-VD3 deficiency and poor glycemic control.